Acceptability of no-test medical abortion provided via telemedicine during Covid-19: analysis of patient-reported outcomes

Erlank, Chelsey Porter; Lord, Jonathan; Church, Kathryn

doi:10.1136/bmjsrh-2020-200954

Cited by 40 publications

(49 citation statements)

References 11 publications

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“…The desire for privacy and confidentiality in this study supports an increasing body of evidence documenting people's preferences in abortion care, and that different models of out of clinic care are safe, acceptable, and sometimes preferable for abortion seekers [20][21][22]. This aligns with the World Health Organization Guidelines on Self-care Interventions for Health [23] which confirms that self-managed abortion is medically safe if pregnant individuals have information on effective protocols and access to follow up health care if needed [23].…”

Section: Discussionsupporting

confidence: 69%

Understanding abortion seeking care outside of formal health care settings in Cape Town, South Africa: a qualitative study

et al. 2021

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Background Although abortion was legalized in South Africa in 1996, barriers to safe, legal abortion services remain, and women continue to seek abortions outside of the formal healthcare sector. This study explored the decision-making processes that women undertake when faced with an unintended pregnancy, the sources of information used to make their decisions and the factors that contribute to their seeking of informal sector abortion in Cape Town, South Africa. Methods We conducted 15 semi-structured in-depth interviews in English with women who had accessed an abortion outside of the formal health care sector. Women were recruited with the assistance of a community-based key informant. Data was analyzed using a thematic analysis approach. Results Participants were aware that abortions were legal and accessible in public clinics, however they were concerned that others would find out about their unintended pregnancy and abortion if they went to legal providers. Women were also concerned about judgment and mistreatment from providers during their care. Rather than seek care in the formal sector, women looked past concerns around the safety and effectiveness of informal sector abortions and often relied on their social networks for referrals to informal providers. Conclusions The findings highlight the decision-making processes employed by women when seeking abortion services in a setting where abortion is legal and demonstrate the role of institutional and societal barriers to safe abortion access. Abortion service delivery models should adapt to women’s needs to enhance the preferences and priorities of those seeking abortion care-including those who prefer facility-based care as well as those who might prefer self-managed medical abortions.

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Section: Discussionsupporting

confidence: 69%

Understanding abortion seeking care outside of formal health care settings in Cape Town, South Africa: a qualitative study

et al. 2021

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“…Two of the providers (BPAS and MSUK) collected patient feedback during the study period. Patients were invited to provide feedback 1–3 weeks after treatment, either by telephone using a structured interview tool (MSUK) 18 or using an online form (BPAS). 19 We analysed data on questions reporting on satisfaction, future preference and privacy.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness, safety and acceptability of no‐test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study

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Lord³

et al. 2021

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Objective To compare outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine.Design Cohort analysis.Setting The three main abortion providers.Population or sample Medical abortions at home at ≤69 days' gestation in two cohorts: traditional model (in-person with ultrasound, n = 22 158) from January to March 2020 versus telemedicine-hybrid model (either in person or via telemedicine without ultrasound, n = 29 984, of whom 18 435 had no-test telemedicine) between April and June 2020. Sample (n = 52 142) comprises 85% of all medical abortions provided nationally.Methods Data from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences.Main outcome measures Treatment success, serious adverse events, waiting times, gestation at treatment, acceptability.Results Mean waiting time from referral to treatment was 4.2 days shorter in the telemedicine-hybrid model and more abortions were provided at ≤6 weeks' gestation (40% versus 25%, P < 0.001). Treatment success (98.8% versus 98.2%, P > 0.999), serious adverse events (0.02% versus 0.04%, P = 0.557) and incidence of ectopic pregnancy (0.2% versus 0.2%, P = 0.796) were not different between models. In the telemedicine-hybrid model, 0.04% were estimated to be over 10 weeks' gestation at the time of the abortion; all were completed safely at home. Within the telemedicine-hybrid model, effectiveness was higher with telemedicine than in-person care (99.2% versus 98.1%, P < 0.001). Acceptability of telemedicine was high (96% satisfied) and 80% reported a future preference for telemedicine.Conclusions A telemedicine-hybrid model for medical abortion that includes no-test telemedicine and treatment without an ultrasound is effective, safe, acceptable and improves access to care.

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“…These findings align with other research showing that home-based and telemedicine first trimester MA are safe with high rates of efficacy and acceptability ( 17 , 18 ). Existing research in several high-income nations also suggests providers may be interested in maintaining the liberalized practice changes implemented since the beginning of the COVID-19 pandemic ( 19 , 20 ). However, more research is required to assess the sustainability of these regulatory changes.…”

Section: Introductionmentioning

confidence: 99%

The perspective of Canadian health care professionals on abortion service during the COVID-19 pandemic

et al. 2021

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Background The COVID-19 pandemic and pandemic response created novel challenges for abortion services. Canada was uniquely positioned to transition to telemedicine because internationally common restrictions on abortion medication were removed before the pandemic. Objective We sought to characterize the experiences of abortion health care professionals in Canada during the COVID-19 pandemic and the impact of the pandemic response on abortion services. Methods We conducted a sequential mixed methods study between July 2020 and January 2021. We invited physicians, nurse practitioners and administrators to participate in a cross-sectional survey containing an open-ended question about the impact of the pandemic response on abortion care. We employed an inductive codebook thematic analysis, which informed the development of a second, primarily quantitative survey. Results Our initial survey had 307 respondents and our second had 78. Fifty-three percent were family physicians. Our first survey found respondents considered abortion access essential. We identified three key topicss: access to abortion care was often maintained despite pandemic-related challenges (e.g. difficulty obtaining tests, additional costs); change of practice to low-touch medication abortion care and provider perceptions of patient experience, including shifting demand, telemedicine acceptability and increased rural access. The second survey indicated uptake of telemedicine medication abortion among 89% of participants except in Quebec, where regulations meant procedures were nearly exclusively surgical. Restrictions did not delay care according to 76% of participants. Conclusions Canadian health care professionals report their facilities deemed abortion an essential service. Provinces and territories, except Quebec, described a robust pandemic transition to telemedicine to ensure access to services. Podcast An accompanying podcast is available in the Supplementary Data, in which the authors Dr Madeleine Ennis and Kate Wahl discuss their research on how family planning care and access to abortion services have changed during the COVID-19 pandemic.

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Acceptability of no-test medical abortion provided via telemedicine during Covid-19: analysis of patient-reported outcomes

Cited by 40 publications

References 11 publications

Understanding abortion seeking care outside of formal health care settings in Cape Town, South Africa: a qualitative study

Understanding abortion seeking care outside of formal health care settings in Cape Town, South Africa: a qualitative study

Effectiveness, safety and acceptability of no‐test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study

The perspective of Canadian health care professionals on abortion service during the COVID-19 pandemic

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